<script language="javascript" type="text/javascript" src="valida_registrar.js"></script>

<div id="mainBody">
	<div class="container">
	<div class="row">
	
	<div class="span8">
	<h3> Cadastro</h3>	
	<div class="well">

	<form method="post" name="form1" action="salvar_registro.php" >
		<h4>Informa&ccedil&otildees Pessoais</h4>
		<h5><sup>(*)</sup> Campos de preenchimento obrigat&oacuterio.</h5>
		<div class="row">
			<div class="span3 ">
				<label class="" for="nome">Nome Completo <sup>(*)</sup></label>
				<input class="span3" type="text" id="nome" name="nome" placeholder="Seu nome">
			</div>
		 </div>
		 <div class="row">
			<div class="span3">
				<label class="" for="email">Email <sup>(*)</sup></label>
				<input class="span3" type="text" id="email" name="email" placeholder="Email">
			</div>
			<div class="span3">
				<label class="" for="conf_email">Confirme seu Email <sup>(*)</sup></label>
				<input class="span3" type="text" name="conf_email" id="conf_email" placeholder="Confirme o Email">
			</div>
		</div>
		<div class="row">
			<div class="span3">
				<label class="" for="senha">Senha <sup>(*)</sup></label>
				<input class="span3" type="password" id="senha" name="senha" placeholder="Senha">
			</div>
			<div class="span3">
				<label class="" for="conf_senha">Confirme sua Senha <sup>(*)</sup></label>
				<input class="span3" type="password" id="conf_senha" name="conf_senha" placeholder="Senha">
			</div>
		</div>	  
		<br>

		<h4>Endere&ccedilo</h4>
		<div class="row">
			<div class="span3">
				<label class="" for="">Endere&ccedilo <sup>(*)</sup></label>
				<input type="text" id="endereco" class="span3" name="endereco" placeholder="Rua Salgado Filho, 775 - Centro">
			</div>
			<div class="span3">
				<label class="" for="cidade">Cidade <sup>(*)</sup></label>
				<select name="cidade" id="cidade" class="span3">
					<option value='selecione'>Selecione...</option>
					<option  value ="1">Corumb&aacute</option>
				  	<option value ="2">Lad&aacuterio</option>
				</select>
			</div>
		</div>
		<div class="row">
			<div class="span3">
				<label class="" for="fone">Fone</label>
				<input type="text" class="span3" id="fone" name="fone" placeholder="(67) 3226-1063" onkeypress="MascaraTelefone(form1.fone);" >
			</div>
			<div class="span3">
				<label class="" for="fone2">Fone(2)</label>
				<input class="span3" type="text" id="fone2" name="fone2" placeholder="(67) 9999-6113" onkeypress="MascaraTelefone(form1.fone2);" >
			</div>
		</div>
		</br>
		
		<div class="row">
			<div class="span3"></div>
			<div class="span3">
				<input type="submit" value="Salvar" class="btn btn-large btn-success pull-right" name="Enviar" onclick="return valida()" >
			</div>
		</div>	
	</form>
</div>

</div>
</div>
</div>
</div>